title: Efficacy of combined levonorgestrel-releasing intrauterine system with gonadotropin-releasing hormone analog for the treatment of adenomyosis.
abstract: OBJECTIVE
  To evaluate the clinical outcomes of gonadotropin-releasing hormone analog (GnRHa) combined with implantation of a levonorgestrel-releasing intrauterine system (LNG-IUS) in adenomyosis patients with significantly enlarged uteruses.
  
  
  METHODS
  Twenty-one adenomyosis patients whose uterine volumes were greater in size than at 12 weeks' gestation were recruited for the study. Subcutaneous injection of GnRHa was administrated at an interval of 28 days for a total of 3-4 cycles when uterine length was determined to be less than 10 cm by ultrasound measurement. At 3, 6 and 12 months after LNG-IUS implantation, follow-up was performed to document the clinical values such as uterine volume, degree of dysmenorrhea and menstrual flow.
  
  
  RESULTS
  Twelve months after implantation, the menstrual flow was significantly lower than baseline values (53.8 ± 11.7 vs. 100, p = 0.03). The degree of dysmenorrhea (pain) was relieved 12 months after implantation (58.2 ± 11.5 vs. 93.7 ± 0.2, p = 0.005). Uterine volume was also below pre-GnRHa levels after implantation (276.6 ± 32.1 vs. 311.4 ± 32.3, p = 0.005). LNG-IUS was expelled in 3 patients, giving an expulsion rate of 14%. Side effects of GnRHa combined with LNG-IUS implantation were few.
  
  
  CONCLUSIONS
  The findings indicate that combined GnRHa and LNG-IUS treatment was efficacious in patients with enlarged adenomyosis.
authors.affiliation: Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, Shandong Province, PR China.
authors.forename: Peihai
authors.initials: P
authors.lastname: Zhang
authors.forename: Kun
authors.initials: K
authors.lastname: Song
authors.forename: Li
authors.initials: L
authors.lastname: Li
authors.forename: Kazunori
authors.initials: K
authors.lastname: Yukuwa
authors.forename: Beihua
authors.initials: B
authors.lastname: Kong
mesh_terms: D062788:Adenomyosis / Q000188:drug therapy*; D016503:Drug Delivery Systems; D004412:Dysmenorrhea / Q000188:drug therapy; D005260:Female; D017273:Goserelin / Q000008:administration & dosage* / Q000627:therapeutic use; D006801:Humans; D007436:Intrauterine Devices, Medicated; D016912:Levonorgestrel / Q000008:administration & dosage* / Q000627:therapeutic use; D009929:Organ Size; D010146:Pain / Q000188:drug therapy; D011372:Progestins / Q000008:administration & dosage* / Q000627:therapeutic use; D014599:Uterus / Q000473:pathology
chemical_list: D011372:Progestins; D017273:Goserelin; D016912:Levonorgestrel